Rheumatoid arthritis (RA) is a disease that inflames the tissues in your body. The most common symptoms are pain and swelling in your joints. But RA can also cause a number of other problems, including with your eyes.
In your joints, RA attacks cartilage that covers the ends of your bones. That tissue is made mostly of collagen. That's the same stuff that makes up much of your eye, including the white part of your eyeball (also known as the sclera) and the clear lens that covers it (the cornea).
Eye Problems From RA
Dry eye. This is far more likely if you have RA. Among those with RA, dry eye is more common in women.
Your eye may feel as if there is sand or grit in it, and it might water more than usual. This often gets worse after you sleep, read, or watch a screen like your computer, smartphone, or TV. Low humidity, air conditioning, and wind could make your symptoms worse.
Without treatment, dry eye can cause pain and swelling and could lead to infection. Dry eye can also bring scarring of your cornea, which your doctor might call keratitis.
In some cases, dry eye is a sign of another autoimmune disease called Sjogren’s syndrome that can cause dry mouth. Sjogren’s syndrome is more common in people with RA.
Scleritis. RA can inflame and thin the white outer layer of your eye. That can be serious because the thinner layer can split if you get an injury. Scleritis is more common in people between 40 and 70. You might notice:
- Red eyes that don’t go away
- Pain
- Swelling
- Light sensitivity
- Irritation or itchiness
- Occasional vision problems
Uveitis. Here, RA inflames the uvea. That's the layer of tissue between the back of your eye (the retina) and the sclera. In addition to eye pain and light sensitivity, blurry vision is likely with uveitis. Your doctor might call it “iritis” when the inflammation and irritation affect just your iris, the colored part of your eye.
Diagnosis of Eye Problems Tied to RA
Your doctor will ask questions about your medical history and symptoms. They'll also take a close look at your eyes. In some cases, they might take a small sample of fluid, pus, or other material from your eye.
You may need a special eye doctor called an ophthalmologist to pinpoint your eye problem. An arthritis doctor called a rheumatologist might help assess your RA. Together, these two doctors can figure out which treatment is best for you.
Treatment of Eye Problems Tied to RA
First, your rheumatologist will treat the RA, which will also help your eye problem. This might start with over-the-counter drugs like nonsteroidal anti-inflammatory drugs (NSAIDs), but it could also include other medicines, like steroids. They may also send you to your eye doctor.
If that happens, depending on the type of eye problem you have, you may get eye drops or ointment with steroids to ease inflammation. If what's going on with your eyes is more severe, your eye doctor may give you oral steroids, and if needed, drugs that power down your immune system, like biologic medicines. You would get these if your eye problem comes from an overactive immune system, the same thing that causes RA.
For dry eyes, ointments to moisten and protect your eyes or drops (artificial tears) can help.
Other Things to Know
Steroid medications can make other eye problems like cataracts and glaucoma worse. They can also make these things more likely for you if you don't already have them. That’s why it’s important to tell your doctor about all your health conditions as well as all the medications that you take.
An often-used treatment for RA called hydroxychloroquine (Plaquenil) has been known to cause damage to the retina in some people. (Your doctor may call it retinal toxicity.)
Talk with your doctor about which treatments might be best for your RA and for your eyes.
